The magicians call it misdirection. It’s when they get you to focus on one thing whilst they are doing something else. I think of the focus on demands for more National Health Service (NHS) funding is an example of misdirection. The focus should be on exploiting technology for public health. Rather than rely on the NHS to tell us if we are healthy, we could use technology to help us self manage our wellness and when we are not well to then seek NHS help. For example, I scanned the gadgets in my house and realised I can tell you my blood pressure, levels of oxygen saturation, heart rate and heart rate variability, amount of sleep and sleep quality, and the glucose levels in my blood. Because I track what I eat, I know the amount of protein, carbohydrate, fat, fibre and nutrients I have consumed. I can even scan my own brain waves and use this information to help me get into a more meditative state. The device I wear on my wrist and have on my bike tracks how much exercise I have done and at what intensity. Because most of these devices all talk to the same app, I have data demonstrating my health over time going back years in an easy to read format. I have all of this stuff because as an enthusiastic amateur ultra-distance athlete I’m keen to optimise my performance and the data helps me work out how to do this. If I needed to, I could share this data with a clinician and seek advice if I was concerned about an abnormal reading.

The ingredients of success

As ‘Fitbit’ style devices measure more and measure it more accurately, a single device that automatically uploads data to an app that tracks what’s happening and flags when something appears wrong means people can self monitor and for the most part self manage their health before things go too far. It’s not about us all becoming doctors. Instead, it’s allowing the technology to do the complex analysis and give us a simple personal dashboard of our state of health and knowing what to do adjust our lifestyle to keep things on track. The devices alone are not enough. Just because people are more aware does not mean they will do anything about it as is shown by people knowing they should exercise more and eat healthily and doing neither. We also need to incentivise people. To establish a habit, you need three things:

a cue (the thing that triggers the habit)

a routine (what you do once the cue is triggered) and

a reward (the buzz of having completed the routine).

The reward for keeping yourself healthy could come in the form of immediate things such as vibration and firework display that some devices display when you hit the target number of steps walked. We could learn from coffee shops and their loyalty card schemes that work on the notion of goal proximity theory – the closer you are to completing the card the more coffee you are likely to buy. Delayed gratification could come in the form of reduced taxes. Each visit to the doctor, dentist or hospital costs substantial amounts of money. If you look after yourself and avoid the need to use these services then you should share in the savings made. It’s not just the government that should be rewarding ‘well’ behaviour but companies too. Reducing absence due to sickness should come with a bonus and be part of an individual’s annual review. To make it more fun we need to learn from the success of computer games and make a game of the exercise of maintaining wellness.

We’ve done it before

To achieve this society lead drive to better healthcare and a move away from a dependency on the NHS may seem like a tall order, but we’ve done it successfully before. The fact we now all wear seat belts in cars was a function of a sustained campaign of communication, education and finally legislation. The same will be required in this instance. We need to help people understand basic principles of wellness. The FAST campaign aimed at helping people recognise when someone is having a stroke is an excellent example of how a whole population can be educated around a specific issue. Secondly, we need to educate people into the routine we wish them to follow. It’s not about using the technology, it’s about what to do when the technology alerts you to an issue. A great example of this is the alertness monitoring systems in new cars that sense when you are beginning to show signs of sleepiness at the wheel and alert you that it’s time to take a break. The algorithms and technology that underpin these systems are complex and this is irrelevant to the user, the key thing is a simple alert on the screen that advises you for your own safety and that of other road users, to take a break. We will need legislation as was the case with the introduction of laws that mandated the use of seatbelts in the interest of everyone. We need to make it a requirement in law that you take care of yourself. We have plenty of existing legislation that already demonstrates this is possible such as health and safety legislation. We also need to ensure the technology is measuring consistently, reliably and accurately the biometric feedback needed to make this work. We’re not there yet but it’s getting close. The optical sensors that measure heart rate in wrist devices are good at recording heart rate but less good at determining the variability. The way devices monitor sleep still needs some work to match the data from the current gold standards of measurement. And above all we need to continue to integrate these technologies into single devices that use a common language to communicate with the users’ preferred application and we need to make the process as easy as possible.

The cultural norm

It’s not a question of ‘can we do this?’ Early adopters of such technology have proven it’s possible. The question is how do we make this a mainstream cultural norm that means it’s simply the way we do things. What is clear is that as long as we continue to focus on the NHS as the principal focus for resources to ensure our health and well-being and abdicate responsibility to others, we are missing a trick. That’s good for magicians, but not so useful for us.

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